scholarly journals Emerging Socioeconomic Disparities in COVID-19 Vaccine Second-Dose Completion Rates in the United States

Vaccines ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 121
Author(s):  
Autumn Gertz ◽  
Benjamin Rader ◽  
Kara Sewalk ◽  
John S. Brownstein

Although COVID-19 vaccination plans acknowledge a need for equity, disparities in two-dose vaccine initiation have been observed in the United States. We aim to assess if disparity patterns are emerging in COVID-19 vaccination completion. We gathered (n = 843,985) responses between February and November 2021 from a web survey. Individuals self-reported demographics and COVID-19 vaccination status. Dose initiation and completion rates were calculated incorporating survey weights. A multi-variate logistic regression assessed the association between income and completing vaccination, accounting for other demographics. Overall, 57.4% initiated COVID-19 vaccination, with 84.5% completing vaccination. Initiation varied by income, and we observed disparities in completion by occupation, race, age, and insurance. Accounting for demographics, higher incomes are more likely to complete vaccination than lower incomes. We observe disparities in completion across annual income. Differences in COVID-19 vaccination completion may lead to two tiers of protection in the population, with certain sub-groups being better protected from future infection.

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S218-S219
Author(s):  
Elizabeth M La ◽  
Diana Garbinsky ◽  
Shannon Hunter ◽  
Sara Poston ◽  
Patricia Novy ◽  
...  

Abstract Background The Advisory Committee on Immunization Practices (ACIP) routinely recommends several adolescent vaccines, including human papillomavirus (HPV); quadrivalent meningococcal conjugate (MenACWY); and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines. Limited data are available on the percentage of adolescents receiving this complement of ACIP-recommended vaccines and factors that may increase likelihood of completion. Methods This study used 2015–18 pooled National Immunization Survey-Teen (NIS-Teen) data to estimate national and state-level completion rates by age 17 of a two-dose MenACWY series, two- or three- dose HPV series (depending on age at first vaccination), and a Tdap vaccine, using multivariable logistic regression modeling to adjust for individual characteristics. NIS-Teen data were then combined with public state-level data to construct a multilevel model evaluating effects of both individual- and state-level factors on completion. Results After adjusting for individual-level factors, the national completion rate for these ACIP-recommended vaccines by age 17 was 30.6% (95% confidence interval [CI]: 30.1–31.0%). However, rates for individual states varied substantially, from 11.3% in Idaho (CI: 6.9–18.0%) to 56.4% in Rhode Island (CI: 49.8–62.8%) (Figure 1). In the multilevel model, individual characteristics associated with increased likelihood of receiving the recommended vaccines by age 17 included female gender, black or Hispanic race, Medicaid coverage (vs. private/other), last provider visit at age 16 or 17, generally having ≥1 provider visit in last year, and receiving a provider recommendation for HPV vaccination. Residing in a state with a MenACWY vaccination mandate for elementary and secondary schools was the only state-level variable that significantly increased the likelihood of completion (odds ratio: 1.6; CI: 1.2–2.3) (Figure 2). Figure 1: Model-Adjusted Completion Rates of ACIP-Recommended HPV, MenACWY, and Tdap Vaccines by Age 17 Years in the United States, 2015–18. ACIP, Advisory Committee on Immunization Practices; HPV, human papillomavirus; MenACWY, quadrivalent meningococcal conjugate; Tdap, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis. Note: Vaccination completion is based on completion of the HPV series (i.e., receipt of 2 doses for individuals aged 9–14 years at first vaccination or receipt of 3 doses for individuals aged 15 years or older at first vaccination), completion of the MenACWY series (i.e., receipt of 2 doses), and receipt of a Tdap vaccine. Note: Model-adjusted composite vaccination completion is adjusted for sex, race/ethnicity, mother’s educational attainment, health insurance status, continuity of health insurance coverage since age 11, whether the individual was 16 or 17 years old at their last checkup, number of physician or other healthcare professional visits in past 12 months, whether a doctor or other healthcare professional ever recommended that the individual receive HPV vaccination, and state. The model-adjusted estimate is generated by taking the average of the predicted probability of vaccination for each individual as if they were all from the same state (while retaining all other characteristics). Figure 2: Individual-Level and State-Level Characteristics Associated with an Individual’s Completion of ACIP-Recommended HPV, MenACWY, and Tdap Vaccines by Age 17 Years in the United States, 2015–18. ACIP, Advisory Committee on Immunization Practices; CI, confidence interval; HCP, healthcare professional; HPV, human papillomavirus; MenACWY, quadrivalent meningococcal conjugate; ref, referent category; Tdap, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis. Note: Bold characters and darker circles indicate significant results. Note: Vaccination completion is based on completion of the HPV series (i.e., receipt of 2 doses for individuals aged 9–14 years at first vaccination or receipt of 3 doses for individuals aged 15 years or older at first vaccination), completion of the MenACWY series (i.e., receipt of 2 doses), and receipt of a Tdap vaccine. Conclusion Recommended adolescent vaccine completion rates are suboptimal and highly variable across states. Provider recommendations, visits at 16–17 years of age, and state mandates for MenACWY are implementable strategies associated with completion of recommended adolescent vaccines. Funding GlaxoSmithKline Biologicals SA (study identifier: HO-19-19991) Disclosures Elizabeth M. La, PhD, RTI Health Solutions (Employee) Diana Garbinsky, MS, GSK (Other Financial or Material Support, The study was conducted by RTI Health Solutions, which received consultancy fees from GSK. I am a salaried employee at RTI Health Solutions and received no direct compensation from GSK for the conduct of this study..) Shannon Hunter, MS, GSK (Other Financial or Material Support, Ms. Hunter is an employee of RTI Health Solutions, who received consultancy fees from GSK for conduct of the study. Ms. Hunter received no direct compensation from the Sponsor.) Sara Poston, PharmD, The GlaxoSmithKline group of companies (Employee, Shareholder) Patricia Novy, PhD, GSK (Employee, Shareholder) Parinaz Ghaswalla, PhD, ORCID: 0000-0002-2883-5590, GlaxoSmithKline (Employee, Shareholder)


2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Nicholas Petty ◽  
Dakota King-White ◽  
Tachelle Banks

Abstract Throughout the United States there are millions of Black and Brown students starting the process of attending college. However, research indicates that students from traditionally marginalized groups are less likely than their counterparts to complete the process and graduate college (Shapiro et al., 2017). While retention rates for students from traditionally marginalized backgrounds continue to decline, universities are beginning to pay attention to the needs of this population in search of ways of better supporting them. The examination of these factors may also inform programmatic adjustments, leadership philosophies, and future practices to help retain students and lead to eventual completion of a baccalaureate degree. In this article, the authors review the literature to explore factors that can affect Black and Brown students’ completion rates in higher education. By reviewing the literature and the factors impacting Black and Brown students, the authors share with readers initiatives at one university that are being used to support students from a strengths-based approach.


2018 ◽  
Author(s):  
Robert Robinson

Background Massive open online courses (MOOCs) are technological innovations have been successfully applied in a wide variety of disciplines to deliver quality online education. These courses are an area of intense focus of educational research. Preliminary studies have shown MOOCs to be effective means of delivering medical education. This study reports data on course completion rates and the geographic reach of a MOOC designed for medical education. Methods A online course designed as for a 4th year medical school elective was opened as a free to take MOOC in August, 2014. The course is offered in English with subtitles via Udemy.com. Data regarding completion rates were obtained from the course management interface of the MOOC, data regarding the geographic reach of the course was obtained from Google Analytics. All data is anonymous, aggregated, and studied retrospectively. The intended course audience was fourth year medical students in the United States, but enrollment was open to all. Results MOOC enrollment reached 5,586 students by February, 2018. Completion rates were low (5%), with 8% completing 50% or more of the MOOC. 80% of students did not complete a single course element. Students enrolled from 161 different countries based on localization by Google Analytics. The most common countries students enrolled from were the United States (46%), India (6%), the United Kingdom (4%), Egypt (2.5%), Canada (2.5%), Australia (2%), China (2%), Germany (1.5%), Brazil (1.5%), and Saudi Arabia (1.5%). Conclusions Course enrollment included 5,586 students from 161 different countries. Course completion rates were low, but consistent with other scientific MOOCs designed for high level audiences that are open for public enrollment. These results also show the potential global reach of a MOOC. These factors of high enrollment, low course completion, but global reach are unique challenges for medical educators who deliver content via MOOC technology. Further study is needed to further define the role of MOOCs in medical education.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S601-S602
Author(s):  
Camerin Rencken ◽  
Siraj Amanullah ◽  
Annie Gjelsvik ◽  
Shira Dunsiger

Abstract Background Vaccination coverage among US adults for tetanus, a potentially fatal disease, continues to be lower than the national goals. Education has been considered to have positive impact on vaccination coverage. However, recently there have been outbreaks of vaccine preventable conditions in areas with high college completion rates. This study aims to assess the relationship between education and vaccination coverage. Specifically, we looked at the association between education level and tetanus vaccination status of the US adults. Methods Data from the 2016 Behavioral Risk Factor Surveillance System, a self-reported annual survey for non-institutionalized adults in the United States from the Centers for Disease Control, were analyzed. The outcome was up-to-date tetanus coverage (within the last 10 years) defined by the response to: have you received tetanus vaccine since 2005? Education was stratified into four categories: (1) grade 11 or less, (2) grade 12/GED, 3) college 1–3 years, and (4) college 4 or more years. Bivariate analyses and multivariable logistic regression were conducted on the analytic sample (n = 417,473) using Stata 15, accounting for weighting and the complex survey design of the BRFSS. Results This study identified that 59.9% of US adults are up-to-date on the tetanus vaccine status (Table 1). Higher education level was found to be associated with increased odds of up to date tetanus vaccination. The highest odds were for those with 4 or more years of college education [aOR = 1.31; 95% CI: 1.26–1.35)] while the lowest odds were for those less than grade 11 education, when compared with those with a high school degree [aOR = 0.93; 95% CI: 0.88–0.98] (Figure 1). Other covariates identified as negatively associated with up-to-date tetanus status were race/ethnicity, female sex, unemployment, not being married, not having insurance or a personal healthcare provider, and being above 45 years of age (Figure 1). Conclusion This study identified a positive association between up-to-date tetanus status and higher education level. Introducing community-specific vaccination education programs for those without tertiary education, especially for those above age 45 and without insurance, may help increase the overall vaccination status in the United States. Disclosures All authors: No reported disclosures.


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